Cone beam computed tomography updated technology for endodontic diagnosis

An Overview of Cone-Beam Computed Tomography and Dental Panoramic Radiography in Dentistry in the Community

This study reviews the two most important and frequently used systems of tomography used in dentistry today. These are the dental panoramic radiograph (DPR) and cone-beam computed tomography (CBCT). The importance of the DPR has been accentuated by the recent COVID-19 pandemic, as it does not produce an aerosol. Its clinical importance is derived from its panoramic display of the jaws and associated structures and should be examined for incidental findings that may portend a potentially serious outcome. An important recent spin-off of the DPR is the extra-oral bitewing, which can replace its traditional, uncomfortable and aerosol-generating intra-oral counterpart. Although much has been written about them, this paper reviews their essential attributes and limitations in clinical dentistry. Although attempts have been made to reproduce some of the attributes of CT in CBCT such as Hounsfield Units (HU) and improve the contrast resolution of the soft tissues, these remain elusive. Nevertheless, CBCT's dataset should be appropriately reconstructed to fully display the clinical feature prompting its prescription. In certain cases, more than one mode of reconstruction is required.

Transportation and Centering Ability of Kedo-S Pediatric and Mtwo Instruments in Primary Teeth: A Cone-beam Computed Tomography Study

Background

Cleaning and debriding the canals and preserving the shape of the canal without deformation is the primary goals of pulpectomy. Transportation is a critical endodontic iatrogenic fault that could cause a catastrophe. This study evaluated the canal centering ability and canal transportation caused by Kedo-S pediatric and Mtwo instruments, using a cone-beam computed tomography (CBCT).

Materials and methods

This in vitro study was performed on distal roots of 50 primary mandibular first molars. The teeth were scanned using CBCT and randomly divided into two groups. The canals were then prepared using either Kedo-S or Mtwo files (n = 25). The instrumented canals were rescanned. The scanned volumes were sectioned at 2, 4, and 6 mm from cementoenamel junction (CEJ). Canal transportation (CT) and instrument centering ability were estimated and compared in both groups.

Results

The mean values for two study groups were compared. T -test was used to determine theP value. The Levene's test was used to test the significance between two groups. The two groups showed similar results in terms of transportation and centering ability (P > 0.05).

Conclusion

Kedo-S pediatric and Mtwo instruments demonstrated similar canal centering ability and CTs.

How to cite this article

Haridoss S, Rakkesh KM, Swaminathan K. Transportation and Centering Ability of Kedo-S Pediatric and Mtwo Instruments in Primary Teeth: A Cone-beam Computed Tomography Study. Int J Clin Pediatr Dent 2022;15(S-1):S30-S34.

Effectiveness of digital data acquisition technologies in the fabrication of maxillofacial prostheses - A systematic review

Objective

The systematic review was designed to review and analyze the outcomes of various digital data acquisition technologies used for treatment planning in the prosthetic rehabilitation of maxillofacial defects.

Methods

The review protocol was registered in PROSPERO data with registration number: CRD42020188415. The PICOS inclusion criteria was employed in the systematic review. An electronic search (PubMed, databases) yielded twenty-eight eligible case reports. The qualitative methodological assessment was done according to an article that provided criteria for special considerations in evaluating case reports. It consisted of four questions, each carrying grading of 0, 1, and 2. During the full-text screening, the reviewers shortlisted six outcomes (time, aesthetics, cost, dimensional accuracy, patient satisfaction, and fabrication process) and graded (0, 1, 3) according to the outcomes they met.

Results

The majority of the included case reports used LASER scanners. Auricular and orbital defects were the highest reported cases. In nasal and orbital defects, the mean outcome of the shorter time required for the fabrication was the highest. In auricular prostheses, the mean outcome of dimensional accuracy was highest. In facial prostheses, aesthetics, dimensional accuracy, and patient satisfaction had the highest mean outcome whereas, in obturators, the shorter time required, dimensional accuracy, and patient satisfaction had the highest mean outcome. A total of 18 studies were graded as highly significant studies according to the methodological qualitative assessment.

Conclusion

LASER scanning systems in nasal prostheses, LASER scanners and combination of CT scan and digital photography in auricular prostheses, digital photography and stereophotogrammetry in case of large facial defects and combination of MRI and CT scan for obturators appeared to be a superior method of digital data acquisition.

Endodontic treatment of various palatal root in maxillary molars: Case series and clinical experience

BACKGROUND AND OVERVIEW

The purpose of this article is to present the variations in maxillary molar palatal root canals and provide a reference for the possible variations in root canal treatment.

CASE DESCRIPTION

Five rare cases with palatal canal variation presented in this case series received nonsurgical endodontic treatment successfully. These case reports highlight that understanding and managing the different types of canal configurations in palatal roots of maxillary molars is essential to successful root canal treatment. We tried 2 methods of examining the palatal canal variation to provide examples for clinicians in diagnosing and treating similar cases.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

The outline form of the access cavity and the shape of the pulp chamber floor are important factors for identifying variations in root canal number. Moreover, cone-beam computed tomography can help in detecting variations in root canals.

[Imaginology in the diagnosis and planning of root duct systems: an updated review]

Root canal systems present a varied morphological conformation for each group of teeth. Several authors have described the anatomical conformation and its variants in different classifications, including the main, collateral, lateral, secondary, accessory, interduct, recurrent, apical delta and interradicular cavus canals. Currently, radiology still does not allow visualization of all these structures. However, proper use of imaging techniques together with the use of new 3D equipment for adjustments of acquisition parameters with adequate software and algorithms allows greater image precision, facilitating diagnosis and the planning of the most adequate approach for endodontic treatments. The objective of this article was to conduct a review of the literature to identify new concepts and useful imaging tools for better diagnoses.

The Extent of the Crack on Artificial Simulation Models with CBCT and Periapical Radiography

Background

The aim of this study was to investigate the extent of the crack of a cracked tooth on an artificial simulation model with Periapical Radiography (PR) and cone beam computed tomography (CBCT) in vitro, providing the basis for early diagnosis and an appropriate treatment plan.

Methods

Forty-four teeth with different extents of artificial cracks, created by exposure to liquid nitrogen after hot water at 100°C, were collected. They were subjected to PR and CBCT. Micro-computed tomography (micro-CT) examination, regarded as a relatively more accurate measurement than others, was used to measure and record the crack depth. Three observers, an endodontic graduate student, an experienced endodontist, and an experienced radiologist, examined the PR and CBCT results independently, and the presence or absence of cracks with PR and CBCT were respectively recorded. The external consistency ICC with 95% confidence interval (95% CI) was used to analyze the consistency among the graduate student, endodontist, and radiologist; ROC curves were used for the analysis of diagnostic performance of both radiographic modalities for tooth cracks with crack depth.

Results

For the interpretation of the PR results, there were statistically significant differences among the three different observers (P < 0.001), and the interpretation of the CBCT results (P < 0.001). In the group of results read by the graduate student, the sensitivity of diagnosis with CBCT and PR was 77.27% and 22.73%, respectively (P < 0.001). In the group of results read by the endodontist, the sensitivity of diagnosis with CBCT and PR was 81.81% and 8.19%, respectively (P < 0.001). In the group of results read by the radiologist, the sensitivity of diagnosis with CBCT and PR was 88.64% and 11.36%, respectively (P < 0.001). As for CBCT diagnosis, the critical value for the graduate, endodontist, and radiologist was 3.20 mm, 2.06 mm, and 1.24 mm, respectively. For the PR diagnosis, the critical value for the graduate, endodontist, and radiologist was 6.12 mm, 6.94 mm, and 6.94 mm, respectively.

Conclusions

Within the limitations of this study, on an artificial simulation model of cracked teeth for early diagnosis, we recommend that it would be better for a cracked tooth to be diagnosed by a radiologist with CBCT than PR, CBCT with a minimum depth of 1.24 mm.

Cone-beam computed tomography as advanced diagnostic aid in endodontic treatment of molars with multiple canals: Two case reports

The purpose of these case reports is to emphasize the importance of knowledge regarding the root canal morphology and current diagnostic aids one should have as both of these important factors going to affect the prognosis of the endodontic treatment. These two case reports describe the maxillary and mandibular first molars with multiple canals. After clinical and radiographic diagnosis, additional help of cone-beam computed tomography (CBCT) of mandibular molar has been taken to evaluate the morphology and canal pattern; while maxillary molar was evaluated using CBCT scan to evaluate the canal configuration and obturation. In CBCT evaluation, the mandibular molar was diagnosed with six separated canals with three mesial and three distal canals and with radix paramolaris and radix entomolaris. The maxillary molar had five canals with three mesiobuccal (MB) canals. Both molars were instrumented with conventional hand and rotary file systems and obturated by conventional lateral compaction method. The axial images from CBCT show Vertucci Type VIII canal pattern in both roots of first mandibular molars and in MB root of maxillary first molar Sert and Bayirli Type XVIII canal configuration and no accessory canal in distobuccal and palatal root. With the recent innovations in diagnostic and operating aids, we can come across many variations in the root canal morphology of both mandibular and maxillary teeth, especially multi-rooted one (i.e., molars), and the knowledge of which leads to successful endodontic treatment with an excellent prognosis.